Detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III)

Population-based epidemiologic studies have uncovered the high prevalence and wide severity spectrum of undiagnosed obstructive sleep apnea, and have consistently found that even mild obstructive sleep apnea is associated with significant morbidity. Evidence from methodologically strong cohort studies indicates that undiagnosed obstructive sleep apnea, with or without symptoms, is independently associated with increased likelihood of hypertension, cardiovascular disease, stroke, daytime sleepiness, motor vehicle accidents, and diminished quality of life. Strategies to decrease the high prevalence and associated morbidity of obstructive sleep apnea are critically needed. The reduction or elimination of risk factors through public health initiatives with clinical support holds promise. Potentially modifiable risk factors considered in this review include overweight and obesity, alcohol, smoking, nasal congestion, and estrogen depletion in menopause. Data suggest that obstructive sleep apnea is associated with all these factors, but at present the only intervention strategy supported with adequate evidence is weight loss. A focus on weight control is especially important given the expanding epidemic of overweight and obesity in the United States. Primary care providers will be central to clinical approaches for addressing the burden and the development of cost-effective case-finding strategies and feasible treatment for mild obstructive sleep apnea warrants high priority.

Epidemiology of obstructive sleep apnea: a population health perspective.

Advances in flavonoid research since 1992.

Polyphenols are the most abundant antioxidants in the diet and are widespread constituents of fruits, vegetables, cereals, dry legumes, chocolate, and beverages, such as tea, coffee, or wine. Experimental studies on animals or cultured human cell lines support a role of polyphenols in the prevention of cardiovascular diseases, cancers, neurodegenerative diseases, diabetes, or osteoporosis. However, it is very difficult to predict from these results the effects of polyphenol intake on disease prevention in humans. One of the reasons is that these studies have often been conducted at doses or concentrations far beyond those documented in humans. The few clinical studies on biomarkers of oxidative stress, cardiovascular disease risk factors, and tumor or bone resorption biomarkers have often led to contradictory results. Epidemiological studies have repeatedly shown an inverse association between the risk of myocardial infarction and the consumption of tea and wine or the intake level of some particular flavonoids, but no clear associations have been found between cancer risk and polyphenol consumption. More human studies are needed to provide clear evidence of their health protective effects and to better evaluate the risks possibly resulting from too high a polyphenol consumption.

Dietary polyphenols and the prevention of diseases

Summary
BACKGROUND AND OBJECTIVE The original Whlckham Survey documented the prevalence of thyroid disorders in a randomly selected sample of 2779 adults which matched the population of Great Britain in age, sex and social class. The aim of the twenty-year follow-up survey was to determine the Incidence and natural history of thyroid disease in this cohort.

DESIGN, PATIENTS AND MEASUREMENTS Subjects were traced at follow-up via the Electoral Register, General Practice registers, Gateshead Family Health Services Authority register and Office of Population Censuses and Surveys. Eight hundred and twenty-five subjects (30% of the sample) had died and, In addition to death certificates, two-thirds had Information from either hospital/General Practitioner notes or post-mortem reports to document morbidity prior to death. Of the 1877 known survivors, 96% participated in the follow-up study and 91 % were tested for clinical, biochemical and Immunological evidence of thyroid dysfunction.

RESULTS Outcomes in terms of morbidity and mortality were determined for over 97% of the original sample. The mean Incidence (with 95% confidence Intervals) of spontaneous hypothyroidism in women was 3.5/1000 survivors/year (2.8-4.5) rising to 4.1/1000 survivors/year (3.3-5.0) for all causes of hypothyroidism and in men was 0.6/1000 survivors/year (0.3-1.2). The mean incidence of hyperthyroidism In women was 0.8/1000 survivors/year (0.5.1.4) and was negligible in men. Similar incidence rates were calculated for the deceased subjects. An estimate of the probability of the development of hypothyroidism and hyperthyroidism at a particular time, i.e. the hazard rate, showed an Increase with age In hypothyroidism but no age relation in hyperthyroidism.

The frequency of goitre decreased with age with 10% of women and 2% of men having a goitre at follow-up, as compared to 23% and 5% in the same subjects respectively at the first survey. The presence of a goitre at either survey was not associated with any clinical or biochemical evidence of thyroid dysfunction. In women, an association was found between the development of a goitre and thyroid-antibody status at follow-up, but not initially.

The risk of having developed hypothyroidism at follow-up was examined with respect to risk factors Identified at first survey. The odds ratios (with 95% confidence Intervals) of developing hypothyroidism with (a) raised serum TSH alone were 8 (3-20) for women and 44 (19-104) for men; (b) positive anti-thyroid antibodies alone were 8 (5-15) for women and 25 (10-63) for men; (c) both raised serum TSH and positive anti-thyroid antibodies were 38 (22-65) for women and 173 (81-370) for men. A loglt model Indicated that Increasing values of serum TSH above 2mU/l at first survey Increased the probability of developing hypothyroidism which was further Increased in the presence of anti-thyroid antibodies. Neither a positive family history of any form of thyroid disease nor parity of women at first survey was associated with Increased risk of developing hypothyroidism. Fasting cholesterol and triglyceride levels at first survey when corrected for age showed no association with the development of hypothyroidism In women.

CONCLUSIONS This historical cohort study has provided Incidence data for thyroid disease over a twenty-year period for a representative cross-sectional sample of the population, and has allowed the determination of the importance of prognostic risk factors for thyroid disease Identified twenty years earlier.

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The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey

policy decisions may be difficult to comprehend from the viewpoint of a rational decision-making ethos such as that of the NHMRC, it is a mistake to think that the decisionmaking process is opaque, secretive and not accountable. Ministers with any sense rarely, if ever, make significant policy decisions without ensuring that they have received advice that can stand public scrutiny. There are too many avenues for information to make its way into the public arena via the media for crude ad hoc-ery and suppression to reign. Major decisions have to be ratified by parliaments. Ministers must face Question Time. Departmental officers are subject to overview by parliamentary estimates committees. Auditors General do \"value-for-money\" audits, and aggrieved interest groups have access to judicial and administrative review procedures. Moreover, few stakeholders with an interest in policy decisions are willing to take a dispassionate, disinterested approach. In particular, parliamentary democracy is adversarial, and the Opposition will inevitably seize on any flaws in the policy decision-making process to challenge the Minister and the Government. In this schema, medical researchers and scientists are only one interest group in a relatively packed gallery. Government, as a matter of necessity, responds by attempting to manage the decision-making process to prevent what are perceived to be opportunistic attacks by vested interests. While policy decisions not based on rigorous scientific research may appear capricious to the \"expert\", from the policy maker's point of view such decisions may legitimately satisfy the demands of successful lobby groups that have won the debate in the media and the court of public sentiment. Both the criteria for determining what constitutes \"good\" policy and the processes for carrying out the policy are continually contested and revised. Rarely does change result from a continual, comprehensive rational process of review.3 More usually, change is incremental and is a matter of \"muddling through\".4 Most Ministers and senior policy advisers adopt a strategic approach to change. They usually have broad policy goals and an analysis of the steps required to achieve the goals, while they attempt to win over and accommodate the competing demands of the various interest groups affected as progress is made. More infrequently, thoroughgoing reviews and analyses made in response to emerging problems and anomalies result in more decisive change. But, even then, the change that arises must be negotiated with the various interest groups concerned.\" This does not mean that the desire for greater justice, transparency, and accountability in the health policy decision-making process will be fruitless. Scientific methodology and expert opinions are part of the process, but history clearly demonstrates that what is \"good\" science, ethics or philosophy today is tomorrow's discarded theory or, worse, misguided thinking that probably should have been avoided at the time. Preset policy-making principles in the hands of experts so that better decisions can be made for the \"right\" reasons should generally be regarded with scepticism. Scientific and expert opinions are often contested by scientists and experts who disagree among themselves, and even when this does not happen alternative cultural and social standpoints should not be discounted. Ultimately, in our system of government, power is vested with the institutions of representative democracy. Imperfect as governments are, they are accountable to the parliament and ultimately to the electorate, and it is the parliament and the electorate who decide whether the outcomes of and the processes for making health policy are satisfactory. Scientific and expert opinions are only some of a range of inputs into the policy-making process. Policy progresses only by the testing of good ideas in the furnace of political debate.

The weighty issues of perimenopausal and menopausal hormone therapy.

Radioimmunoassay of polypeptide hormones in antibody-coated tubes.

Introduction Though this chapter will deal in detail with the clinical assessment of the male partner in an infertile couple, it is necessary to emphasize (as described in Chapter 2) the importance of treating the couple rather than just the individual. There is no doubt that subfertility frequently occurs in both partners and the effects tend, on the basis of a number of studies, to be synergistic rather than additive. Therefore both partners in any couple with subfertility must be assessed fully and a strategy of investigation and management planned that takes account of them both. Thus the assessment of the male should occur in parallel with the assessment outlined in Chapter 3 for the female partner. With the recent exciting developments in assisted reproductive technologies, particularly as applied to male subfertility (as outlined in Chapter 10), there is a temptation to take a minimalistic approach to the assessment of the male partner and to rely simply on the semen analysis followed by a decision as to whether to proceed to in-vitro fertilization, perhaps with sperm microinjection. It is important to recognize that there are uncommon but potentially treatable and/or preventable causes of male subfertility which should be identified before proceeding to more invasive and expensive technologies. The couple must be made fully aware of the options available to them, including the likely success rates, complications and expenses involved.

The subfertility handbook: Assessment of the male partner

Progress in the area of menopausal research has been hampered by the lack of an agreed staging system that would allow comparison of data obtained by different investigators. Two publications from ...

Henry G. Burger

Papers

The weighty issues of perimenopausal and menopausal hormone therapy.

Radioimmunoassay of polypeptide hormones in antibody-coated tubes.

The subfertility handbook: Assessment of the male partner

The stages of reproductive aging as proposed by workshops held in 2001 and 2010 (STRAW and STRAW + 10): a commentary.

Artificial insemination with cryopreserved donor semen; A decade of experience